Eosinophilic Esophagitis (EoE), Food Triggers, and the Gut–Immune Connection (with Dr. Alan Epstein)

In this episode of My Allergist Dad, Drew and Dr. Z welcome gastroenterologist Dr. Alan Epstein to discuss gut health and its relationship to overall health, focusing on eosinophilic esophagitis (EoE) and why it has become more common since the 2000s. Dr. Epstein explains how EoE is diagnosed by endoscopy and biopsy (over 15 eosinophils per high-power field), how it can cause food impactions, and why triggers can be unclear, sometimes involving foods and possibly environmental factors. They review treatments including proton pump inhibitors, swallowed/topical steroids like budesonide, and dupilumab as a later option, plus the challenges of elimination diets. The conversation expands to celiac testing, microbiome diversity and antibiotics, vagus nerve signaling, and using vibration controlled transient elastography (VCTE) to detect fatty liver early to prevent fibrosis and cirrhosis.00:00 Liver Scan Wakeup Call00:52 Episode Preview and Intro01:45 Meet Dr Alan Epstein03:09 Medicine Beyond Silos06:11 What Is EoE15:46 Treating EoE Options17:08 Root Causes and Diet Triggers20:34 Celiac vs Gluten Sensitivity23:00 Wheat Around the World25:16 Old School Swallow Tests25:50 Why EoE Is Rising26:56 Obesity Toxins and Fatty Liver28:30 FibroScan Explained30:14 EoE Food Impaction Basics32:17 Endoscopic Removal Stories36:13 Ancient Microbiome Findings40:12 Fermented Foods vs Probiotics41:55 GLP-1s and Root Causes45:48 Healthcare System Squeeze48:50 Wrap Up and Disclaimers📩 Have a question for the show?Email: [email protected]